By Veena Sriram, MPH
Dr. Linsey McGoey’s excellent piece, “Power and Money Don’t Necessarily Buy Smart Philanthropy”, in the Chronicles of Philanthropy describes her efforts to conduct a study on the growth of large philanthropic institutions, with an emphasis on the Gates Foundation. The piece refreshingly presented a nuanced take on the role of power in philanthropy, but also crucially, on the role of power in interviewing.
On interviewing, Dr. McGoey makes a critical observation:
This reflection got me thinking about two key issues in elite interviewing. The first is the mechanics of the interview itself, and specifically, the power dynamic between the interviewer and interviewee. The second is about the types of policy questions that heavily rely on elite interviewing, and the seeming discomfort in asking those questions and interrogating decision-making structures in public health. Both issues strongly affect the quality of an interview, and, given the primacy of in-depth interviewing in health policy analysis, deserve further examination from the health policy and systems research community.
On the first issue, the interplay of power and interviewing in policy analysis is a fascinating and thorny issue, and raises a range of methodological considerations for health policy and systems researchers. Policy analysis often requires us to interview people in high positions of authority – essentially, elites. All types of interviewing involve a negotiation of power dynamics, but the distinguishing feature of elite interviewing is that interviewees occupy a relatively high societal, political or cultural position in the ‘pecking order’, while interviewers can be classified as elites as well. Sometimes both interviewer and interviewee occupy places in the same ecosystem, even though their levels of power within that system could be very different (for example, a student researcher interviewing the head of a major research institution in the same field). You are then essentially interviewing someone in your network, which could have consequences down the road, depending on what is discussed.
From a methodological standpoint, the “positionality” of the interviewer when interviewing elites sets the tone of the interview. A complex mix of factors – age, gender, race, ethnicity, the language that the interview is conducted in, institutional affiliations, contacts, professionalism – and, most importantly, how the interviewee perceives that mix of factors, influences the conversation. I find myself thinking about slot machines, and how fortunes are dictated by chance alignment – elite interviewing can sometimes feel very similar. The randomness of it all can be disconcerting, especially when put in the context of the growing recognition of health policy and systems research as a rigorous science.
Interviewing around potentially sensitive topics deserves an additional level of scrutiny. Many interesting health policy questions require an engagement with topics that people are often less than comfortable discussing, such as egos, corruption, rivalries, etc. Interviewees, particularly those currently in office or in visible positions of power, can be extremely cautious when discussing more sensitive issues – and why wouldn’t they be, when they are suddenly face-to-face with an unknown researcher with an unknown agenda? Many policymakers and decision makers do not want to get embroiled in any kind of negative publicity, and they might perceive interviews for a study as coming dangerously close to interviews for a media story. Consent processes and recorders add a layer of formality that, while necessary, can completely change the tone of an interview, often for the worse. The openness of the interviewee and the quality of the interview then rests completely on the mix of factors discussed earlier.
This leads to the second issue – the overall discomfort in unpacking decision making at the highest levels in public health at each level, be it local, provincial, national, global or everything in between. What accounts for the immense hesitancy that Dr. McGoey speaks of in addressing why certain policies are made, how they are made, the people and power dynamics involved, and whether these policymaking processes can be improved upon?
Perhaps it is because the stakes are high. In the case of policy analysis involving elites, we are dealing with relatively small networks in which information travels quite freely. There is sometimes a belief that what is said in the confidential space of an interview is actually being broadcast to a much larger audience, particularly if the researcher is not very experienced. Despite all the disclaimers and ethics processes that researchers incorporate to create a sense of trust, it can be truly hard to shake off that kind of fear, particularly if interviewees have had their fingers burnt in the past.
It could also be that these interviews often require a great deal of introspection on the part of the interviewer in order to tease out the nitty-gritty details of policymaking, which may be unrealistic in the course of a one hour interview – especially if the interviewee and interviewer are meeting for the first time, amidst the mix of personal and professional factors discussed above. Questions about who got along with whom, the dynamics of the network, and what they did right or wrong ask a lot from interviewees. Yet we expect them to give unsparingly honest assessments, essentially to strangers, all the while knowing the risks of this information leaking out in some way. It’s a tall order.
As health policy and systems research grows as a subset of health research, explorations into decision-making structures will become more commonplace than is the case today. But as Dr. McGoey found, investigating these organizations can result in all kinds of barriers for researchers, particularly for organizations that are not typically used to interrogation, or possibly, criticism. However, as she rightly says, the lack of criticism of an organization does not mean it is past reproach – quite the opposite. It means that the organization has attained a level of power that insulates it from the spotlight. As researchers, we need to start to think deeply about how to engage with these kinds of power dynamics in the research process, and to do so in a way that combines scientific rigor and artful diplomacy. There seem to be few hard and fast rules, but reflecting carefully about these issues can contribute to those characteristics that we wish for in all types of research – validity and reliability – and ultimately contribute to a more accurate and in-depth picture of policymaking in public health.